The Effectiveness of Dialectical Behavior Therapy in Reducing Self-Directed Violence and Suicidality in Usual Care Settings: A Meta-Analysis
Abstract
Dialectical behavior therapy (DBT) has shown efficacy in reducing suicidality, though less is known about its effectiveness when delivered in usual care (UC) settings, where the resource-intensive nature of the program often results in modifications during implementation. This systematic meta-analysis examined the effectiveness of DBT in reducing suicidality-related outcomes when delivered in usual care settings. A systematic search was conducted and studies were identified for inclusion if they evaluated a DBT-based intervention with original, quantitative data reflecting pre- and post-treatment measurement of at least one of the three suicidality-related outcomes: (i) self-directed violence (SDV), (ii) crisis service use (CSU), and (iii) suicidal ideation (SI). Random effects models were used to estimate pooled effects. Meta-regression analyses were used to compare pooled effects across usual care and non-usual care settings and to examine the differential effects of theoretical predictors often involved in treatment modification. The final sample included 83 studies. In uncontrolled studies, DBT was associated with a large reduction in SDV and medium reductions in CSU and SI. In controlled studies, DBT demonstrated a significant effect for SDV but not for CSU or SI. Adjustment for publication bias attenuated the CSU findings. No differences were observed between usual care and non-usual care settings. Substantial heterogeneity was observed across models. In uncontrolled…
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